Study On Resilience In Accidentally Injured Patients And Resilience Enhanced Model

[Objectives]To explore the elements and level of resilience in accidentally injured patients aftermotor vehicle accidents and work-place events, their experience in resilience buildingprocess.To identify factors and strategies that influence resilience of patients and todevelop a resilience-enhanced model of accidentally injured patients to facilitate theresilience and add clinical psychological evidence to nursing theory for accidentialinjured patients.[Methods]1. Literature analysis was conducted to explore the influencing factors of resilienceand the appropriate process of resilience building and theoretical foundation of this study.2. Using mixed methods design, a cross-sectional study was conducted. A quantitativestudy was conducted and the questionnaires were sent to280accidentally injuredpatients.The instruments include the CD-RISC resilience scale, the medical coping modesquestionnaire (MCMQ), the big five inventory (BFI), the general self-efficacy scale(GSES), perceived social support scale (PSSS), The satisfaction with life scale (SWLS), tomeasure resilience, stress coping, personality trait, self-efficacy, social support and thesatisfaction with life, respectively. Data were processed using the SPSS (StatisticalPackage for the Social Sciences)16.0software. Pearson correlation techniques were usedto examine the relationships between resilience and demographic and injury severitycharacteristics, personality characteristics, coping styles, self efficacy, perceived socialsupport and satisfaction with life. A stepwise multiple regression analysis was performed toexamine the contribution by correlated variables to the report of resilience. The qualitativestudy by using semi-structured in-depth interview was conducted in23accidentally injuredpatients. Transcripts were analyzed using phenomenological analysis to explore theexperiences, process and main influencing factors of patients' resilience.3. An initial intervention model to facilitate resilience of accidentally injured patientswas developed based on theoretical analysis, quantitative study and qualitative study.[Results]1. By literature review and theoretical analysis, an initial conceptual framework wasdeveloped to guide the whole research. 2.Quantitative study results: Firstly, the average score of resilience in accidentallyinjured was66.22±13.49(n=280). Secondly, there was no significant difference in theaverage resilience score in accidentally injured between different demographic groups, butthe level of resilience was negatively correlated with injury severity score(r=-0.170,P<0.01)and the treatment time for trauma(r=-0.166, P <0.01). Thirdly, The level ofresilience in accidentally injured was correlated with some subscales of personality,including openness (r=0.313, P <0.01),extraversion (r=0.248, P<0.01), andconscientiousnes(sr=0.248,P <0.01)of BFI. But it was not correlated with agreeablenessand neuroticism of BFI. The resilience of accidentally injured was positively correlatedwith self efficacy(r=0.454,P <0.01), social support (r=0.295,P <0.01), satisfaction withlife(r=0.259,P <0.01).The level of resilience of accidentally injured was correlated withsubscales of coping styles and positive correlation with avoidance coping style(r=0.178,P <0.01), negative correlation with resignation coping style(.r=-0.275,P <0.01)was foundrespectively.The main influence factors for resilience in accidentally injured were selfefficacy, resignation coping style, the treatment time for trauma, ISS grades, social supportand conscientiousness.All variables entering the model could explain31.4%of thevariance of resilience. Among them the valiables of self efficacy, social support andconscientiousness were positive prediction factors,but the valiables of resignation copingstyles, treatment time for trauma,ISS were negative prediction factors.The self efficacyalone can explain20.4%of the variance of resilience, which means it is the main predictorfor resilience.3. Qualitative study results: First, the key elements of resilience in accidentallyinjured include: acceptance, personal competence, tolerance of stress, social support, andhope. Second, the process of resilience buiding in accidentally injured can be summarizedas three stages, that is pain and grief stage, acceptance stage and reforming andrehabilitation stage. The influencing factors for resilience in accidentally injured weresome traits of personality (i.e. optimistic, Self-confidence, conscientiousness, humorousand locus of control) and protective factors in environment, which is social support, healthresources support, and coping style. The risk influencing factors of resilience includesymptoms of disease, rehabilitation of uncertainty for the trauma and worries for thefuture.4. Based on the qualitative and quantitative results, an enhanced model for resiliencein accidentally injured patients was developed. [Conclusions]1. The average level of resilience in accidentally injured patients was low.2. The levels of resilience in accidentally injured patients were influenced by ISS,personality, self efficacy, and social support. The level of resilience in accidentally injuredwas negatively correlated significantly with injury severity score, and was correlated withsubscales of personality, i.e. openness, extraversion, and conscientiousness of BFI. But itwas not correlated with agreeableness and neuroticism of BFI. The level of resilience inaccidentally injured was positively correlated with self efficacy, social support and thesatisfaction with life. Correlation can also be found between the level of resilience inaccidentally injured and subscales of coping styles, that is positive correlation withavoidance coping style and negative correlation with resignation coping styles.3. The main prediction factors for resilience in accidentally injured patients were selfefficacy, resignation coping, treatment time for trauma, ISS grades, social support andconscientiousness. Among them the valiable of self efficacy, social support andconscientiousness were positive prediction factors, but the valiables of resignation copingstyles, treatment time for trauma, ISS grades were negative prediction factors.The selfefficacy is the main predictor for resilience.4. The key elements of resilience in accidentally injured patients include acceptance,personal competence, tolerance stress, social support and hope.5. An initial resilience-enhanced model in accidentely injured patients was developed,which can provide guidance for the intervention to improve the resilience in accidentallyinjured patient.